The present invention relates generally to medical probes, and particularly to balloon catheters.
Various catheters employ steering mechanisms so as to maneuver their distal end. For example, U.S. Patent Application Publication 2015/0173772 describes a catheter system utilizing one or more sensors. The catheter can be used as part of an embolic coil system, guidewire system, or combined embolic coil/guidewire system where the devices interact with the catheter system. A variable detachment embolic coil system and guidewire system are also described, wherein part of a device is detached to leave an implant behind.
As another example, U.S. Patent Application Publication 2004/0193032 describes a diagnostic catheter with a steering device to direct the distal end of the catheter while it is inserted in a vessel. The catheter may include either a bi-directional steering mechanism, or a unidirectional steering mechanism. The catheter may be embodied as a basket catheter including a plurality of splines. A central retractable and steerable member is included to provide the expansion force. The expansion force can also be provided by moving the proximal portion of the catheter relative to the central member. Each of the splines forming the basket includes a length of spring wire disposed therein to provide conformal forces causing the splines to conform to the surfaces being inspected.
U.S. Pat. No. 6,585,717 describes deflection mechanisms that are positioned so as to deflect portions of a flexible body, such as a catheter, in more than one direction in a single plane, as well as in more than one plane. The invention allows a distal portion of a catheter to be deflected more than 360 degrees to provide a loop. In an embodiment, a deflection structure of the catheter may be made of polymer, a spring-tempered stainless or super-elastic alloy that when released from a sheath will force the catheter tip to take a shape desired. Tension may be applied to a pull-wire, thereby causing the deflection structure to bend.
U.S. Pat. No. 5,395,327 describes a steering mechanism including a steering shaft coupled to a controller which includes a handle and apparatus for manipulating the distal end of the steering shaft. The steering shaft includes a flexible coiled spring having a lead spring fixed in position with respect to a distal end thereof in the distal end of the steering shaft. Steering wires are affixed at the distal ends thereof to the lead spring. The steering wires extend through the steering shaft to the controller, and the steering apparatus of the controller is used to place tension on the steering wires. The attachment of the distal ends of the steering wires to the lead spring may be opposite one another or may be offset for providing greater maneuverability. Tension may be placed on the steering wires by wedges mounted transversely to the controller housing, or by rotation of a shaft mounted transversely to the controller housing, the steering wires being attached to the shaft such that rotation in one direction tenses one steering wire, and rotation in the other direction tenses the other steering wire. Two independently rotatable shafts may be used to separately control the two steering wires.
Deflecting a balloon catheter is challenging, particularly if the balloon needs to be maneuvered within the left atrium. The balloon catheter is normally fed (over a guidewire) into the left atrium in a deflated state via a sheath, and it is then inflated or expanded. For correct positioning prior to an ablation, the balloon needs to be inflated or expanded and deflected to the desired location within the heart. However, upon exiting catheter sheath, the relatively small size of the left atrium limits the freedom of movement for deflection of the balloon. Recognizing this, the inventor has devised an invention for the balloon with a mechanism that allows for inflation of the balloon as well as deflection of the balloon, and the two operations can be performed independently.
In particular, an embodiment of the present invention provides a medical probe including a shaft, an expandable membrane and a probe maneuvering assembly (PMA). The shaft is configured for insertion into a cavity of an organ of a patient. The PMA is located inside the expandable membrane and includes a first elastic element, which is fitted along a longitudinal axis of the PMA and is configured to expand the membrane by shortening the PMA, and to collapse the membrane by elongating the PMA. The PMA further includes a second elastic element, which surrounds at least a portion of the first elastic element and is configured to deflect the membrane relative to the longitudinal axis.
In some embodiments, a length of the second elastic element is configured to determine a bending-location over the PMA.
In some embodiments, the medical probe further includes a hollow tube, which runs inside the shaft, wherein a distal edge of the hollow tube is coupled to a distal end of the PMA, for shortening or elongating the PMA.
In some embodiments, the medical probe further includes one or more puller wires, which are connected to the second elastic element for deflecting the membrane.
In an embodiment, the one or more puller wires each comprises a yarn.
In another embodiment, the yarn is made of Ultra High Molecular Weight Polyethylene (UHMWPE) material.
In some embodiments, the medical probe further includes a catheter handle, which includes a ratcheting mechanism configured to rotate so as to control an amount of tension on the one or more puller wires.
In an embodiment, the catheter handle includes a rocker configured to deflect the PMA using the one or more puller wires, wherein a center of the rocker has an opening for passing the hollow tube.
In some embodiments, the first and second elastic elements comprise respective first and second springs.
In an embodiment, the first and second springs are helical, wherein the first spring has a first handedness, and wherein the second spring has a second handedness that is opposite to the first handedness.
In some embodiments, the second elastic element is a flexible tube.
In some embodiments, the medical probe further includes a ring, which is slid over the flexible tube and is connected to the one or more puller wires.
In an embodiment, a portion of the flexible tube wraps a coupling member at a distal edge of the shaft, wherein the coupling member couples the PMA to the shaft.
In another embodiment, a proximal edge of the expandable membrane is coupled to the flexible tube.
There is additionally provided, in accordance with an embodiment of the present invention, a manufacturing method including mounting inside an expandable membrane a probe maneuvering assembly (PMA) that includes (a) a first elastic element, which is fitted along a longitudinal axis of the PMA and is configured to expand the membrane by shortening the PMA, and to collapse the membrane by elongating the PMA, and (b) a second elastic element, which surrounds at least a portion of the first elastic element and is configured to deflect the membrane relative to the longitudinal axis. The PMA and the membrane are connected at a distal edge of a shaft for insertion into a cavity of an organ of a patient using a coupling member.
There is additionally provided, in accordance with an embodiment of the present invention, a method including inserting, into a cavity of an organ of a patient, a probe including (a) a shaft, (b) an expandable membrane, and (c) a probe maneuvering assembly (PMA), which is located inside the expandable membrane, wherein the PMA includes (i) a first elastic element fitted along a longitudinal axis of the PMA, and (ii) a second elastic element surrounding at least a portion of the first spring. Using the first elastic element, the membrane is expanded by shortening the PMA, and the membrane is collapsed by elongating the PMA. The membrane is deflected relative to the longitudinal axis using the second elastic element.
The present invention will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings in which:
Overview
The following detailed description should be read with reference to the drawings, in which like elements in different drawings are identically numbered. The drawings, which are not necessarily to scale, depict selected embodiments and are not intended to limit the scope of the invention. The detailed description illustrates by way of example, not by way of limitation, the principles of the invention. This description will clearly enable one skilled in the art to make and use the invention, and describes several embodiments, adaptations, variations, alternatives and uses of the invention, including what is presently believed to be the best mode of carrying out the invention.
As used herein, the terms “about” or “approximately” for any numerical values or ranges indicate a suitable dimensional tolerance that allows the part or collection of components to function for its intended purpose as described herein. More specifically, “about” or “approximately” may refer to the range of values±10% of the recited value, e.g. “about 90%” may refer to the range of values from 81% to 99%. In addition, as used herein, the terms “patient,” “host,” “user,” and “subject” refer to any human or animal subject and are not intended to limit the systems or methods to human use, although use of the subject invention in a human patient represents a preferred embodiment. As well, the term “proximal” indicates a location closer to the operator whereas “distal” indicates a location further away to the operator or physician.
Embodiments of the present invention that are described hereinafter provide medical probes, such as expandable balloon catheters having a probe maneuvering assembly (PMA). The PMA enables to, independently and simultaneously, expand or collapse a balloon membrane, as well as deflect the balloon membrane, a mode of operation called “maneuvering the balloon” in the context of the disclosed description. The disclosed embodiments of a PMA thus increase the freedom of movement to, for example, deflect the balloon inside a small-size cavity of a patient's organ, such as inside the left atrium of a heart.
In some embodiments, a shaft including a hollow tube for insertion into the cavity is provided, wherein the hollow tube runs inside the hollow shaft. The PMA, which is coupled at its proximal edge to the distal edge of the shaft using a coupling member, is further coupled, at a nose piece included in a distal edge of the PMA, to the distal edge of the hollow tube (i.e., a distal edge of the hollow tube is coupled to a distal end of the PMA). The PMA further includes (a) a first elastic element, which is fitted along a longitudinal axis of the PMA and is configured to expand the membrane by shortening the PMA, and to collapse the membrane by elongating the PMA, and (b) a second elastic element, which surrounds at least a portion of the first elastic element and is configured to deflect the membrane relative to the longitudinal axis.
In some embodiments, the first and second elastic elements are springs. In other embodiments the PMA includes a flexible tube as the second elastic element instead of the second spring. Typically, the flexible tube is made of polymer material that can be extruded to form the tube. Other suitable types of elastic elements can also be used to implement the first and/or second elastic element.
The expandable membrane of a balloon surrounds the PMA with a distal edge of the expandable membrane coupled to the nose piece. A proximal edge of the expandable membrane is coupled to the distal edge of the shaft. The expandable membrane can be either expanded or collapsed when pulling or releasing the hollow tube, respectively, while, in parallel, it can be deflected by pulling one or more puller wires. In other words, the expandable membrane is either expanded or collapsed when the PMA is shortened or elongated, respectively, and is simultaneously deflected when the PMA is deflected.
In some embodiments, the second (outer) elastic element is shorter than the first (inner) elastic element in the distal direction. In this way, the outer elastic element does not constrain longitudinal motion (i.e., contraction or elongation) of the inner elastic element. The two elastic elements are nested, and the hollow tube nests within the inner elastic element, so as to minimize the overall diameter of the PMA. In some embodiments, in which the elastic elements are springs, the two springs may have opposite handedness so that helices of the two springs do not overlap.
In other embodiments, in which the second elastic element is a flexible tube, the flexible tube wraps the coupling member at a distal edge of the shaft and covers at least a proximal portion of the first elastic element. A metal ring is slid over the distal edge of the flexible tube, with the puller-wires coupled to the metal ring so as to deflect the flexible tube. The puller wires are inserted through dedicated channels (e.g., extrusions) along the wall of the flexible tube, as described below.
The above-described two embodied arrangements of the components of the PMA allows the deflection of the balloon closer to the geometrical center of the balloon. Therefore, the arc length of the deflection is smaller than the length of a typical left atrium, significantly increasing the utility of this type of maneuvering method.
In some embodiments, the puller wire is made from ultra-high molecular weight polyethylene (UHMWPE) yarn. The coupling of the yarn to the outer spring is resistant to sharp bending (i.e., deflection) of the outer spring, as the yarn does not require welding to the distal edge of the spring, which, as the spring bends, is a potential point of delamination of other types of puller wires. The UHMWPE yarn is terminated directly in the catheter handle, in a ratcheting mechanism that is integrated into the molded handle. The ratcheting mechanism allows the assembler to finely control, during manufacturing, the amount of slack on each yarn by rotating the ratchet mechanism.
The hollow tube is fixed, inside the handle, to a block which glides in a path defined by a rotating knob which provides the retraction necessary to pull the distally located nose piece backward, and to compress the inner spring, so as to shorten the PMA. Proximal to the rotating knob is the bidirectional rocker which provides bidirectional deflection of the balloon.
In an embodiment, the center of the rocker has an opening to allow the hollow tube to pass through without having to take a sharp bend, which is critical to reduce the insertion/retraction forces experienced by the hollow tube.
The hollow tube is configured to be retracted or relapsed from the handle of the catheter so as to expand or collapse the membrane. The puller wires are configured to be pulled or released from the handle in parallel to the motion of the hollow tube, so as to deflect the membrane in parallel (i.e., maneuvering the balloon together, as defined above).
In some embodiments, a related balloon treatment method is provided to enable maneuvering the balloon inside a cavity, so as to access target tissue with the expandable membrane. This additional balloon maneuvering establishes firm physical contact between the expanded membrane and target tissue, at which time the tissue is treated, for example, by applying radiofrequency ablation using electrodes disposed over the expandable membrane in physical contact with tissue.
The disclosed PMA, and the related balloon treatment method, gives a physician access to tissue with a balloon catheter that might otherwise be less accessible, or inaccessible, to balloon treatment limited to the simple maneuvers available to catheters without the disclosed PMA and PMA maneuvering method. Such maneuverability increases the chances of successful completion of a diagnostic and/or invasive therapeutic cardiac procedure, such as pulmonary vein isolation (PVI) from inside the left atrium for treatment of atrial fibrillation.
System Description
During the insertion of balloon catheter 40, balloon catheter 40 is maintained in a collapsed configuration by sheath 23. By containing balloon catheter 40 in a collapsed configuration, sheath 23 also serves to minimize vascular trauma along the way to the target location.
Physician 30 then maneuvers catheter 40 inside cavity 45 using catheter handle 31 so as to access and contact target tissue. In the process, physician 30 simultaneously and independently maneuvers balloon 44 that is fitted for these maneuvers with the disclosed PMA, as described below.
The proximal end of catheter 21 is connected to a control console 24. In the embodiment described herein, catheter 21 may be used for any suitable therapeutic and/or diagnostic purpose, such as electrical sensing, or balloon angioplasty and ablation of tissue in heart 26, among other possible medical usages of expandable balloon catheters.
Control console 24 comprises a processor 41, typically a general-purpose computer, with a suitable front end and interface circuits 38 for receiving signals from catheter 21, as well as for applying treatment via catheter 21 in heart 26 and for controlling the other components of system 20. Processor 41 typically comprises a general-purpose computer, which is programmed in software to carry out the functions described herein. The software may be downloaded to the computer in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory.
The example configuration shown in
Balloon Catheter with High Articulation
The following description of
As seen, PMA 55 comprises nose 51 and a concentric two-spring mechanism 53. A second (outer) spring 52 of concentric two-spring mechanism 53 is coupled at its proximal end to coupling member 22 and encompasses a portion of first (inner) spring 50 to form the concentric arrangement of the two springs (i.e., the aforementioned concentric two-spring mechanism 53).
Nose 51 is coupled to a distal edge of inner spring 50, and can be pulled proximally, or extended distally, by retracting or releasing a hollow tube 54, against the expanding force of inner spring 50, respectively. Therefore, membrane 44 can be expanded or collapsed by pulling or releasing tension, respectively, in hollow tube 54 from catheter handle 31.
In some embodiments, when hollow tube 54 is pulled to compress inner spring 50, membrane 44 expands into a spherical shape, a process which may be further assisted by flowing saline solution under pressure into the balloon, for example, through hollow tube 54. In some embodiments, hollow tube 54 is made of a thick-walled polyimide tube, which also serves as the lumen through which a thin guidewire can pass.
As seen, a puller wire 56 is attached to a distal end of second (outer) spring 52, at an anchoring point 57A. When pulled by a puller wire 56, outer spring 52 bends, causing PMA 55 to bend and to deflect expandable membrane 44 (i.e., deflect the balloon catheter). Typically, outer spring 52 is designed to be shorter and stiffer than inner spring 50. In an embodiment, the length of outer spring 52 is chosen so as to cause the bending of balloon maneuvering assembly 55 at a bending point 59A, at a given distance proximally to anchoring point 57A. Another puller wire (not shown) is coupled to outer spring 52 directly opposite to puller wire 56 to enable bi-directional deflection of balloon catheter 40.
In the context of this description, terms such as “deflection,” “deflect” and “deflectable” refer to a situation in which a longitudinal axis 530 of the PMA is at some non-zero angle relative to a longitudinal axis 270 of shaft 27 (e.g., longitudinal axis 530 is pointing at a deflected direction 530′ that is not parallel with the longitudinal axis).
In other embodiments, anchoring point 57A is located at a given location along outer spring 52 (along longitudinal axis 530 of the PMA), such as at approximately the center of outer spring 52. The more proximal puller wire anchoring point 57A the tighter the bend radius of outer spring 52, and stiffer and more difficult to deflect. An optimized location of point 57A would occur to a person skill in the art.
In an embodiment, to give a firm structure to PMA 55A, both springs 50 and 52 are sized to have minimal gaps between each other and hollow tube 54. To reduce friction, springs 50 and 52 are electropolished to round corners, and their handedness is reversed so as to prevent one helical cut to fall within the gap of the other spring, thus avoiding obstructing the maneuvering of balloon catheter 40.
Nose 51 is coupled to a distal edge of inner spring 50, and can be pulled proximally, or extended distally, by retracting or releasing a hollow tube 54, against the expanding force of inner spring 50, respectively. Therefore, membrane 44 can be expanded or collapsed by pulling or releasing tension, respectively, in hollow tube 54 from catheter handle 31.
As seen, a puller wire 56 is attached to a ring 66 slid over the distal end of flexible tube 62, at an anchoring point 57B over ring 66. When pulled by a puller wire 56, flexible tube 62 bends, causing PMA 55 to bend and to deflect expandable membrane 44 (i.e., deflect the balloon catheter). Typically, flexible tube 62 is designed to be shorter and stiffer than inner spring 50. In an embodiment, the length of outer spring 52 is chosen so as to cause the bending of balloon maneuvering assembly 55 at a bending point 59B, at a given distance proximally to anchoring point 57B. Another puller wire (not shown) is coupled to ring 66 directly opposite to puller wire 56 to enable bi-directional deflection of balloon catheter 40B.
In an embodiment, to give a firm structure to PMA 55B, the wall of flexible tube 62 is braded with a mesh made of woven metal wires (not shown). The example illustrations shown in
Two puller-wires 56 are implemented as UHMWPE yarns, alternatively Liquid Crystal Polymer, or any other suitable polymer may be used. Yarns 56 go into pulley assembly 63 that includes a rotating knob to bidirectionally deflect balloon catheter 40. Yarns 56 are then tethered to ratcheting mechanisms 60, which are integrated into the molded handle. Ratcheting mechanisms 60 allow, during manufacturing, fine control of the amount of slack on each yarn by rotating the ratchet mechanism by “one click” that equals a length of L/N, where L is the circumference of the ratchet, and N is the number of the ratchet teeth. As further seen, the center of pulley assembly 62 has an opening to allow hollow tube 54 to pass through without having to take a sharp bend, so as to reduce the insertion/retraction forces experienced by the hollow tube. Alternatively, puller wires may be made of stainless steel or any other suitable wire. The yarn may be attached to the ratchet and around the pulley and then secured to the wire.
The example illustration shown in
Physician 30 then further maneuvers the balloon using PMA 55, so as to establish firm contact between membrane 44 and target tissue, at a balloon contacting step 76. The physician next treats target tissue, at a balloon treatment step 78, for example by radiofrequency ablation using the electrodes disposed on membrane 44 that were maneuvered into contact with tissue.
The example flow chart shown in
Although the embodiments described herein mainly address pulmonary vein isolation, the methods and systems described herein can also be used in other applications, such as in otolaryngology or neurology procedures.
It will thus be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described herein above. Rather, the scope of the present invention includes both combinations and sub-combinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art. Documents incorporated by reference in the present patent application are to be considered an integral part of the application except that to the extent any terms are defined in these incorporated documents in a manner that conflicts with the definitions made explicitly or implicitly in the present specification, only the definitions in the present specification should be considered.
This application is a continuation of prior filed U.S. patent application Ser. No. 16/216,686 filed on Dec. 11, 2018 which is hereby incorporated by reference as set forth in full herein.
Number | Name | Date | Kind |
---|---|---|---|
4276874 | Wolvek et al. | Jul 1981 | A |
4699147 | Chilson et al. | Oct 1987 | A |
4734093 | Bonello | Mar 1988 | A |
4940064 | Desai | Jul 1990 | A |
5207229 | Winters | May 1993 | A |
5215103 | Desai | Jun 1993 | A |
5255679 | Imran | Oct 1993 | A |
5293869 | Edwards et al. | Mar 1994 | A |
5309910 | Edwards et al. | May 1994 | A |
5313943 | Houser et al. | May 1994 | A |
5324284 | Imran | Jun 1994 | A |
5345936 | Pomeranz et al. | Sep 1994 | A |
5365926 | Desai | Nov 1994 | A |
5395327 | Undquist | Mar 1995 | A |
5396887 | Imran | Mar 1995 | A |
5400783 | Pomeranz et al. | Mar 1995 | A |
5411025 | Webster, Jr. | May 1995 | A |
5415166 | Imran | May 1995 | A |
5456254 | Pietroski et al. | Oct 1995 | A |
5465717 | Imran et al. | Nov 1995 | A |
5476495 | Kordis et al. | Dec 1995 | A |
5499981 | Kordis | Mar 1996 | A |
5526810 | Wang | Jun 1996 | A |
5546940 | Panescu et al. | Aug 1996 | A |
5549108 | Edwards et al. | Aug 1996 | A |
5558073 | Pomeranz et al. | Sep 1996 | A |
5577509 | Panescu et al. | Nov 1996 | A |
5595183 | Swanson et al. | Jan 1997 | A |
5598848 | Swanson et al. | Feb 1997 | A |
5609157 | Panescu et al. | Mar 1997 | A |
5628313 | Webster, Jr. | May 1997 | A |
5681280 | Rusk et al. | Oct 1997 | A |
5722401 | Pietroski et al. | Mar 1998 | A |
5722403 | McGee et al. | Mar 1998 | A |
5725525 | Kordis | Mar 1998 | A |
5730128 | Pomeranz et al. | Mar 1998 | A |
5766192 | Zacca | Jun 1998 | A |
5772590 | Webster, Jr. | Jun 1998 | A |
5782899 | Imran | Jul 1998 | A |
5823189 | Kordis | Oct 1998 | A |
5881727 | Edwards | Mar 1999 | A |
5893847 | Kordis | Apr 1999 | A |
5904680 | Kordis et al. | May 1999 | A |
5911739 | Kordis et al. | Jun 1999 | A |
5928228 | Kordis et al. | Jul 1999 | A |
5968040 | Swanson et al. | Oct 1999 | A |
6014579 | Pomeranz et al. | Jan 2000 | A |
6014590 | Whayne et al. | Jan 2000 | A |
6119030 | Morency | Sep 2000 | A |
6142993 | Whayne et al. | Nov 2000 | A |
6216043 | Swanson et al. | Apr 2001 | B1 |
6216044 | Kordis | Apr 2001 | B1 |
6321749 | Toti | Nov 2001 | B1 |
6428537 | Swanson et al. | Aug 2002 | B1 |
6456864 | Swanson et al. | Sep 2002 | B1 |
6574492 | Ben-Haim et al. | Jun 2003 | B1 |
6584345 | Govari | Jun 2003 | B2 |
6585717 | Wittenberger et al. | Jul 2003 | B1 |
6600948 | Ben-Haim et al. | Jul 2003 | B2 |
6738655 | Sen et al. | May 2004 | B1 |
6741878 | Fuimaono et al. | May 2004 | B2 |
6748255 | Fuimaono et al. | Jun 2004 | B2 |
6780183 | Jimenez, Jr. et al. | Aug 2004 | B2 |
6837886 | Collins et al. | Jan 2005 | B2 |
6866662 | Fuimaono et al. | Mar 2005 | B2 |
6892091 | Ben-Haim et al. | May 2005 | B1 |
6970730 | Fuimaono et al. | Nov 2005 | B2 |
6973340 | Fuimaono et al. | Dec 2005 | B2 |
6980858 | Fuimaono et al. | Dec 2005 | B2 |
7048734 | Fleischman et al. | May 2006 | B1 |
7149563 | Fuimaono et al. | Dec 2006 | B2 |
7255695 | Falwell et al. | Aug 2007 | B2 |
7257434 | Fuimaono et al. | Aug 2007 | B2 |
7399299 | Daniel et al. | Jul 2008 | B2 |
7410486 | Fuimaono et al. | Aug 2008 | B2 |
7522950 | Fuimaono et al. | Apr 2009 | B2 |
RE41334 | Beatty et al. | May 2010 | E |
7846157 | Kozel | Dec 2010 | B2 |
7930018 | Harlev et al. | Apr 2011 | B2 |
8007495 | McDaniel et al. | Aug 2011 | B2 |
8048063 | Aeby et al. | Nov 2011 | B2 |
8103327 | Harlev et al. | Jan 2012 | B2 |
8167845 | Wang et al. | May 2012 | B2 |
8224416 | De La Rama et al. | Jul 2012 | B2 |
8235988 | Davis et al. | Aug 2012 | B2 |
8346339 | Kordis et al. | Jan 2013 | B2 |
8435232 | Aeby et al. | May 2013 | B2 |
8447377 | Harlev et al. | May 2013 | B2 |
8498686 | Grunewald | Jul 2013 | B2 |
8517999 | Pappone et al. | Aug 2013 | B2 |
8545490 | Mihajlovic et al. | Oct 2013 | B2 |
8560086 | Just et al. | Oct 2013 | B2 |
8567265 | Aeby et al. | Oct 2013 | B2 |
8712550 | Grunewald | Apr 2014 | B2 |
8755861 | Harlev et al. | Jun 2014 | B2 |
8825130 | Just et al. | Sep 2014 | B2 |
8906011 | Gelbart et al. | Dec 2014 | B2 |
8936612 | Suehara | Jan 2015 | B2 |
8945120 | McDaniel et al. | Feb 2015 | B2 |
8979839 | De La Rama et al. | Mar 2015 | B2 |
9037264 | Just et al. | May 2015 | B2 |
9131980 | Bloom | Sep 2015 | B2 |
9204929 | Solis | Dec 2015 | B2 |
9277960 | Weinkam et al. | Mar 2016 | B2 |
9314208 | Altmann et al. | Apr 2016 | B1 |
9339331 | Tegg et al. | May 2016 | B2 |
9486282 | Solis | Nov 2016 | B2 |
9554718 | Bar-Tal et al. | Jan 2017 | B2 |
D782686 | Werneth et al. | Mar 2017 | S |
9585588 | Marecki et al. | Mar 2017 | B2 |
9597036 | Aeby et al. | Mar 2017 | B2 |
9687297 | Just et al. | Jun 2017 | B2 |
9693733 | Altmann et al. | Jul 2017 | B2 |
9782099 | Williams et al. | Oct 2017 | B2 |
9788895 | Solis | Oct 2017 | B2 |
9801681 | Laske et al. | Oct 2017 | B2 |
9814618 | Nguyen et al. | Nov 2017 | B2 |
9833161 | Govari | Dec 2017 | B2 |
9894756 | Weinkam et al. | Feb 2018 | B2 |
9895073 | Solis | Feb 2018 | B2 |
9907609 | Cao et al. | Mar 2018 | B2 |
9974460 | Wu et al. | May 2018 | B2 |
9986949 | Govari et al. | Jun 2018 | B2 |
9993160 | Salvestro et al. | Jun 2018 | B2 |
10014607 | Govari et al. | Jul 2018 | B1 |
10028376 | Weinkam et al. | Jul 2018 | B2 |
10034637 | Harlev et al. | Jul 2018 | B2 |
10039494 | Altmann et al. | Aug 2018 | B2 |
10045707 | Govari | Aug 2018 | B2 |
10078713 | Auerbach et al. | Sep 2018 | B2 |
10111623 | Jung et al. | Oct 2018 | B2 |
10130420 | Basu et al. | Nov 2018 | B2 |
10136828 | Houben et al. | Nov 2018 | B2 |
10143394 | Solis | Dec 2018 | B2 |
10172536 | Maskara et al. | Jan 2019 | B2 |
10182762 | Just et al. | Jan 2019 | B2 |
10194818 | Williams et al. | Feb 2019 | B2 |
10201311 | Chou et al. | Feb 2019 | B2 |
10219860 | Harlev et al. | Mar 2019 | B2 |
10219861 | Just et al. | Mar 2019 | B2 |
10231328 | Weinkam et al. | Mar 2019 | B2 |
10238309 | Bar-Tal et al. | Mar 2019 | B2 |
10278590 | Salvestro et al. | May 2019 | B2 |
D851774 | Werneth et al. | Jun 2019 | S |
10314505 | Williams et al. | Jun 2019 | B2 |
10314507 | Govari et al. | Jun 2019 | B2 |
10314648 | Ge et al. | Jun 2019 | B2 |
10314649 | Bakos et al. | Jun 2019 | B2 |
10349855 | Zeidan et al. | Jul 2019 | B2 |
10350003 | Weinkam et al. | Jul 2019 | B2 |
10362991 | Tran et al. | Jul 2019 | B2 |
10375827 | Weinkam et al. | Aug 2019 | B2 |
10376170 | Quinn et al. | Aug 2019 | B2 |
10376221 | Iyun et al. | Aug 2019 | B2 |
10398348 | Osadchy et al. | Sep 2019 | B2 |
10403053 | Katz et al. | Sep 2019 | B2 |
10441188 | Katz et al. | Oct 2019 | B2 |
10470682 | Deno et al. | Nov 2019 | B2 |
10470714 | Altmann et al. | Nov 2019 | B2 |
10482198 | Auerbach et al. | Nov 2019 | B2 |
10492857 | Guggenberger et al. | Dec 2019 | B2 |
10542620 | Weinkam et al. | Jan 2020 | B2 |
10575743 | Basu et al. | Mar 2020 | B2 |
10575745 | Solis | Mar 2020 | B2 |
10582871 | Williams et al. | Mar 2020 | B2 |
10582894 | Ben Zrihem et al. | Mar 2020 | B2 |
10596346 | Aeby et al. | Mar 2020 | B2 |
10602947 | Govari et al. | Mar 2020 | B2 |
10617867 | Viswanathan et al. | Apr 2020 | B2 |
10660702 | Viswanathan et al. | May 2020 | B2 |
10667753 | Werneth et al. | Jun 2020 | B2 |
10674929 | Houben et al. | Jun 2020 | B2 |
10681805 | Weinkam et al. | Jun 2020 | B2 |
10682181 | Cohen et al. | Jun 2020 | B2 |
10687892 | Long et al. | Jun 2020 | B2 |
10702178 | Dahlen et al. | Jul 2020 | B2 |
10716477 | Salvestro et al. | Jul 2020 | B2 |
10758304 | Aujla | Sep 2020 | B2 |
10765371 | Hayam et al. | Sep 2020 | B2 |
10772566 | Aujila | Sep 2020 | B2 |
10799281 | Goertzen et al. | Oct 2020 | B2 |
10842558 | Harlev et al. | Nov 2020 | B2 |
10842561 | Viswanathan et al. | Nov 2020 | B2 |
10863914 | Govari et al. | Dec 2020 | B2 |
10881376 | Shemesh et al. | Jan 2021 | B2 |
10898139 | Guta et al. | Jan 2021 | B2 |
10905329 | Bar-Tal et al. | Feb 2021 | B2 |
10912484 | Ziv-Ari et al. | Feb 2021 | B2 |
10918306 | Govari et al. | Feb 2021 | B2 |
10939871 | Altmann et al. | Mar 2021 | B2 |
10952795 | Cohen et al. | Mar 2021 | B2 |
10973426 | Williams et al. | Apr 2021 | B2 |
10973461 | Baram et al. | Apr 2021 | B2 |
10987045 | Basu et al. | Apr 2021 | B2 |
11006902 | Bonyak et al. | May 2021 | B1 |
11040208 | Govari et al. | Jun 2021 | B1 |
11045628 | Beeckler et al. | Jun 2021 | B2 |
11051877 | Sliwa et al. | Jul 2021 | B2 |
11109788 | Rottmann et al. | Sep 2021 | B2 |
11116435 | Urman et al. | Sep 2021 | B2 |
11129574 | Cohen et al. | Sep 2021 | B2 |
11160482 | Solis | Nov 2021 | B2 |
11164371 | Yellin et al. | Nov 2021 | B2 |
20040193032 | Mogul | Sep 2004 | A1 |
20040210121 | Fuimaono et al. | Oct 2004 | A1 |
20050055048 | Dieck et al. | Mar 2005 | A1 |
20060009689 | Fuimaono et al. | Jan 2006 | A1 |
20060009690 | Fuimaono et al. | Jan 2006 | A1 |
20060064058 | Coyle | Mar 2006 | A1 |
20060100669 | Fuimaono et al. | May 2006 | A1 |
20070093806 | Desai et al. | Apr 2007 | A1 |
20070276212 | Fuimaono et al. | Nov 2007 | A1 |
20080234564 | Beatty et al. | Sep 2008 | A1 |
20090312807 | Boudreault et al. | Dec 2009 | A1 |
20110118726 | De La Rama et al. | May 2011 | A1 |
20110160574 | Harlev et al. | Jun 2011 | A1 |
20110190625 | Harlev et al. | Aug 2011 | A1 |
20110245756 | Arora et al. | Oct 2011 | A1 |
20110301597 | McDaniel et al. | Dec 2011 | A1 |
20120116382 | Ku et al. | May 2012 | A1 |
20120143130 | Subrananiam et al. | Jun 2012 | A1 |
20130090651 | Smith | Apr 2013 | A1 |
20130172872 | Subramaniam et al. | Jul 2013 | A1 |
20130172883 | Lopes et al. | Jul 2013 | A1 |
20130178850 | Lopes et al. | Jul 2013 | A1 |
20130190587 | Lopes et al. | Jul 2013 | A1 |
20130296852 | Madjarov et al. | Nov 2013 | A1 |
20140025069 | Willard et al. | Jan 2014 | A1 |
20140052118 | Laske et al. | Feb 2014 | A1 |
20140180147 | Thakur et al. | Jun 2014 | A1 |
20140180151 | Maskara et al. | Jun 2014 | A1 |
20140180152 | Maskara et al. | Jun 2014 | A1 |
20140257069 | Eliason et al. | Sep 2014 | A1 |
20140276712 | Mallin et al. | Sep 2014 | A1 |
20140309512 | Govari et al. | Oct 2014 | A1 |
20150011991 | Buysman et al. | Jan 2015 | A1 |
20150045863 | Litscher et al. | Feb 2015 | A1 |
20150080693 | Solis | Mar 2015 | A1 |
20150105770 | Amit | Apr 2015 | A1 |
20150112255 | Jensen et al. | Apr 2015 | A1 |
20150119878 | Heisel et al. | Apr 2015 | A1 |
20150133760 | Kordis et al. | May 2015 | A1 |
20150133860 | Kordis et al. | May 2015 | A1 |
20150133919 | McDaniel et al. | May 2015 | A1 |
20150173772 | Bowman et al. | Jun 2015 | A1 |
20150208942 | Bar-Tal et al. | Jul 2015 | A1 |
20150250424 | Govari et al. | Sep 2015 | A1 |
20150270634 | Buesseler et al. | Sep 2015 | A1 |
20150342532 | Basu et al. | Dec 2015 | A1 |
20160081746 | Solis | Mar 2016 | A1 |
20160113582 | Altmann et al. | Apr 2016 | A1 |
20160113709 | Maor | Apr 2016 | A1 |
20160183877 | Williams et al. | Jun 2016 | A1 |
20160228023 | Govari | Aug 2016 | A1 |
20160228062 | Altmann et al. | Aug 2016 | A1 |
20160278853 | Ogle et al. | Sep 2016 | A1 |
20160302858 | Bencini | Oct 2016 | A1 |
20160338770 | Bar-Tal et al. | Nov 2016 | A1 |
20170027638 | Solis | Feb 2017 | A1 |
20170065227 | Marrs et al. | Mar 2017 | A1 |
20170071543 | Basu et al. | Mar 2017 | A1 |
20170071544 | Basu et al. | Mar 2017 | A1 |
20170071665 | Solis | Mar 2017 | A1 |
20170095173 | Bar-Tal et al. | Apr 2017 | A1 |
20170100187 | Basu et al. | Apr 2017 | A1 |
20170143227 | Marecki et al. | May 2017 | A1 |
20170156790 | Aujla | Jun 2017 | A1 |
20170172442 | Govari | Jun 2017 | A1 |
20170185702 | Auerbach et al. | Jun 2017 | A1 |
20170202515 | Zrihem et al. | Jul 2017 | A1 |
20170221262 | Laughner et al. | Aug 2017 | A1 |
20170224958 | Cummings et al. | Aug 2017 | A1 |
20170265812 | Williams et al. | Sep 2017 | A1 |
20170281031 | Houben et al. | Oct 2017 | A1 |
20170281268 | Tran et al. | Oct 2017 | A1 |
20170296125 | Altmann et al. | Oct 2017 | A1 |
20170296251 | Wu et al. | Oct 2017 | A1 |
20170347959 | Guta et al. | Dec 2017 | A1 |
20170354338 | Levin et al. | Dec 2017 | A1 |
20170354339 | Zeidan et al. | Dec 2017 | A1 |
20170354364 | Bar-Tal et al. | Dec 2017 | A1 |
20180008203 | Iyun et al. | Jan 2018 | A1 |
20180028084 | Williams et al. | Feb 2018 | A1 |
20180049803 | Solis | Feb 2018 | A1 |
20180085064 | Auerbach et al. | Mar 2018 | A1 |
20180132749 | Govari et al. | May 2018 | A1 |
20180137687 | Katz et al. | May 2018 | A1 |
20180160936 | Govari et al. | Jun 2018 | A1 |
20180160978 | Cohen et al. | Jun 2018 | A1 |
20180168511 | Hall et al. | Jun 2018 | A1 |
20180184982 | Basu et al. | Jul 2018 | A1 |
20180192958 | Wu | Jul 2018 | A1 |
20180206792 | Auerbach et al. | Jul 2018 | A1 |
20180235692 | Efimov et al. | Aug 2018 | A1 |
20180249959 | Osypka | Sep 2018 | A1 |
20180256109 | Wu et al. | Sep 2018 | A1 |
20180279954 | Hayam et al. | Oct 2018 | A1 |
20180303414 | Toth et al. | Oct 2018 | A1 |
20180310987 | Altmann et al. | Nov 2018 | A1 |
20180311497 | Viswanathan et al. | Nov 2018 | A1 |
20180338722 | Altmann et al. | Nov 2018 | A1 |
20180344188 | Govari | Dec 2018 | A1 |
20180344202 | Bar-Tal et al. | Dec 2018 | A1 |
20180344251 | Harlev et al. | Dec 2018 | A1 |
20180344393 | Gruba et al. | Dec 2018 | A1 |
20180360534 | Teplitsky et al. | Dec 2018 | A1 |
20180365355 | Auerbach et al. | Dec 2018 | A1 |
20190000540 | Cohen et al. | Jan 2019 | A1 |
20190008582 | Govari et al. | Jan 2019 | A1 |
20190015007 | Rottmann et al. | Jan 2019 | A1 |
20190030328 | Stewart et al. | Jan 2019 | A1 |
20190053708 | Gliner | Feb 2019 | A1 |
20190059766 | Houben et al. | Feb 2019 | A1 |
20190069950 | Viswanathan et al. | Mar 2019 | A1 |
20190069954 | Cohen et al. | Mar 2019 | A1 |
20190117111 | Osadchy et al. | Apr 2019 | A1 |
20190117303 | Claude et al. | Apr 2019 | A1 |
20190117315 | Keyes et al. | Apr 2019 | A1 |
20190125439 | Rohl et al. | May 2019 | A1 |
20190133552 | Shemesh et al. | May 2019 | A1 |
20190142293 | Solis | May 2019 | A1 |
20190164633 | Ingel et al. | May 2019 | A1 |
20190167137 | Bar-Tal et al. | Jun 2019 | A1 |
20190167140 | Williams et al. | Jun 2019 | A1 |
20190188909 | Yellin et al. | Jun 2019 | A1 |
20190201664 | Govari | Jul 2019 | A1 |
20190209089 | Baram et al. | Jul 2019 | A1 |
20190216346 | Ghodrati et al. | Jul 2019 | A1 |
20190216347 | Ghodrati et al. | Jul 2019 | A1 |
20190231421 | Viswanathan et al. | Aug 2019 | A1 |
20190231423 | Weinkam et al. | Aug 2019 | A1 |
20190239811 | Just et al. | Aug 2019 | A1 |
20190246935 | Govari et al. | Aug 2019 | A1 |
20190298442 | Ogata et al. | Oct 2019 | A1 |
20190314083 | Herrera et al. | Oct 2019 | A1 |
20190328260 | Zeidan et al. | Oct 2019 | A1 |
20190343580 | Nguyen et al. | Nov 2019 | A1 |
20200000518 | Kiernan et al. | Jan 2020 | A1 |
20200008705 | Ziv-Ari et al. | Jan 2020 | A1 |
20200008869 | Byrd | Jan 2020 | A1 |
20200009378 | Stewart et al. | Jan 2020 | A1 |
20200015890 | To et al. | Jan 2020 | A1 |
20200022653 | Moisa | Jan 2020 | A1 |
20200029845 | Baram et al. | Jan 2020 | A1 |
20200046421 | Govari | Feb 2020 | A1 |
20200046423 | Viswanathan et al. | Feb 2020 | A1 |
20200060569 | Tegg | Feb 2020 | A1 |
20200077959 | Altmann et al. | Mar 2020 | A1 |
20200093539 | Long et al. | Mar 2020 | A1 |
20200129089 | Gliner et al. | Apr 2020 | A1 |
20200129125 | Govari et al. | Apr 2020 | A1 |
20200129128 | Gliner et al. | Apr 2020 | A1 |
20200163707 | Sliwa et al. | May 2020 | A1 |
20200179650 | Beeckler et al. | Jun 2020 | A1 |
20200196896 | Solis | Jun 2020 | A1 |
20200205689 | Squires et al. | Jul 2020 | A1 |
20200205690 | Williams et al. | Jul 2020 | A1 |
20200205737 | Beeckler | Jul 2020 | A1 |
20200205876 | Govari | Jul 2020 | A1 |
20200205892 | Viswanathan et al. | Jul 2020 | A1 |
20200206461 | Govari et al. | Jul 2020 | A1 |
20200206498 | Arora et al. | Jul 2020 | A1 |
20200289197 | Viswanathan et al. | Sep 2020 | A1 |
20200297234 | Houben et al. | Sep 2020 | A1 |
20200297281 | Basu et al. | Sep 2020 | A1 |
20200305726 | Salvestro et al. | Oct 2020 | A1 |
20200305946 | DeSimone et al. | Oct 2020 | A1 |
20200397328 | Altmann et al. | Dec 2020 | A1 |
20200398048 | Krimsky et al. | Dec 2020 | A1 |
20210015549 | Haghighi-Mood et al. | Jan 2021 | A1 |
20210022684 | Govari et al. | Jan 2021 | A1 |
20210045805 | Govari et al. | Feb 2021 | A1 |
20210059549 | Urman et al. | Mar 2021 | A1 |
20210059550 | Urman et al. | Mar 2021 | A1 |
20210059608 | Beeckler et al. | Mar 2021 | A1 |
20210059743 | Govari | Mar 2021 | A1 |
20210059747 | Krans et al. | Mar 2021 | A1 |
20210077184 | Basu et al. | Mar 2021 | A1 |
20210082157 | Rosenberg et al. | Mar 2021 | A1 |
20210085200 | Auerbach et al. | Mar 2021 | A1 |
20210085204 | Auerbach et al. | Mar 2021 | A1 |
20210085215 | Auerbach et al. | Mar 2021 | A1 |
20210085387 | Amit et al. | Mar 2021 | A1 |
20210093292 | Baram et al. | Apr 2021 | A1 |
20210093294 | Shemesh et al. | Apr 2021 | A1 |
20210093374 | Govari et al. | Apr 2021 | A1 |
20210093377 | Herrera et al. | Apr 2021 | A1 |
20210100612 | Baron et al. | Apr 2021 | A1 |
20210113822 | Beeckler et al. | Apr 2021 | A1 |
20210127999 | Govari et al. | May 2021 | A1 |
20210128010 | Govari et al. | May 2021 | A1 |
20210133516 | Govari et al. | May 2021 | A1 |
20210145282 | Bar-Tal et al. | May 2021 | A1 |
20210169421 | Govari | Jun 2021 | A1 |
20210169568 | Govari et al. | Jun 2021 | A1 |
20210177294 | Gliner et al. | Jun 2021 | A1 |
20210177356 | Gliner et al. | Jun 2021 | A1 |
20210178166 | Govari et al. | Jun 2021 | A1 |
20210186363 | Gliner et al. | Jun 2021 | A1 |
20210187241 | Govari et al. | Jun 2021 | A1 |
20210196372 | Altmann et al. | Jul 2021 | A1 |
20210196394 | Govari et al. | Jul 2021 | A1 |
20210212591 | Govari et al. | Jul 2021 | A1 |
20210219904 | Yarnitsky et al. | Jul 2021 | A1 |
20210278936 | Katz et al. | Sep 2021 | A1 |
20210282659 | Govari et al. | Sep 2021 | A1 |
20210307815 | Govari et al. | Oct 2021 | A1 |
20210338319 | Govari et al. | Nov 2021 | A1 |
Number | Date | Country |
---|---|---|
111248993 | Jun 2020 | CN |
111248996 | Jun 2020 | CN |
0668740 | Aug 1995 | EP |
0644738 | Mar 2000 | EP |
0727183 | Nov 2002 | EP |
0727184 | Dec 2002 | EP |
2783651 | Oct 2014 | EP |
2699151 | Nov 2015 | EP |
2699152 | Nov 2015 | EP |
2699153 | Dec 2015 | EP |
2498706 | Apr 2016 | EP |
2578173 | Jun 2017 | EP |
3238645 | Nov 2017 | EP |
2884931 | Jan 2018 | EP |
2349440 | Aug 2019 | EP |
3318211 | Dec 2019 | EP |
3581135 | Dec 2019 | EP |
2736434 | Feb 2020 | EP |
3451962 | Mar 2020 | EP |
3972510 | Mar 2022 | EP |
S55106168 | Aug 1980 | JP |
2002360704 | Dec 2002 | JP |
2007503914 | Mar 2007 | JP |
2008513111 | May 2008 | JP |
2014502180 | Jan 2014 | JP |
9421167 | Sep 1994 | WO |
9421169 | Sep 1994 | WO |
9625095 | Aug 1996 | WO |
9634560 | Nov 1996 | WO |
0182814 | May 2002 | WO |
2004087249 | Oct 2004 | WO |
2012100185 | Jul 2012 | WO |
2013052852 | Apr 2013 | WO |
2013162884 | Oct 2013 | WO |
2013173917 | Nov 2013 | WO |
2013176881 | Nov 2013 | WO |
2014176205 | Oct 2014 | WO |
2016019760 | Feb 2016 | WO |
2016044687 | Mar 2016 | WO |
2018111600 | Jun 2018 | WO |
2018191149 | Oct 2018 | WO |
2019084442 | May 2019 | WO |
2019143960 | Jul 2019 | WO |
2020026217 | Feb 2020 | WO |
2020206328 | Oct 2020 | WO |
Entry |
---|
International Search Report and Written Opinion issued in corresponding International Patent Application No. PCT/B2019/060132 dated Mar. 19, 2020. |
International Preliminary Report on Patentability for International Application No. PCT/IB2019/060132, dated Jun. 24, 2021, 9 Pages. |
International Search Report and Written Opinion for International Application No. PCT/IB2019/060132, dated Mar. 19, 2020, 12 Pages. |
Notice of Reasons for Refusal dated Aug. 22, 2023, from Corresponding Japanese Application No. 2021-533211. |
Search Report dated Aug. 25, 2023, from Corresponding Japanese Application No. 2021-533211. |
Number | Date | Country | |
---|---|---|---|
20210308424 A1 | Oct 2021 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 16216686 | Dec 2018 | US |
Child | 17350101 | US |